2214137 preterm labour (ptl) & prelabour rupture of membrane (prom)

Preterm Labour(PTL)&

Prelabour Rupture of Membrane (PROM)

Dr.Saeed Mahmoud MBBS, MRCOG, MRCPI, MIOG

DefinitionsPregnancy datingTerm / Gestational period Different species Labour True/FalseEffacement / Dilatation /DescendROM / PROM / PPROM

Effacement & dilatation

Preterm Labour

Preterm labour (PTL): Presence of contractions which cause progressive effacement and dilatation of the cervix between 24 and 37 weeks’ gestation.

Extreme 24-28 Very 28- 32 Preterm 32-37

Preterm birth (PB): Occurs in 6-10% of pregnancies.

Premature rupture of membranes (PROM)

PROM membrane rupture before the onset of uterine contractions;

PPROM preterm PROM (is the term used when the pregnancy is less than 37 completed weeks of gestation.

PPROM 3% and associated with, approximately

one-third of PTL

Prematurity/ Low birth weightPremature infant: An infant born before 37 weeks of estimated GA.

Low birth weight (LBW): BW<2,500 g

Very low birth weight (VLBW): BW<1,500 g

Extremely low birth weight (ELBW): BW<1,000 g

Terms Related to Prematurity

SGA: Birth weight below the 10th percentile for GA or > 2 standart deviations below the mean for GA.IUGR: A process that causes a reduction in an expected pattern of fetal growth.

1. Symmetric IUGR 2. Asymmetric IUGR (head-sparing

IUGR):

Etiology of Preterm Labour

Spontaneous: a. Idiopathic b. (PPROM)

c. UTI , Asymptomatic bacteriuria d. Infection Bacterial vaginosis e. Multiple pregnancy f. Polyhydramnios g. Uterine congenital anomalies

Iatrogenic: a. Pre-eclampsia 40%

b. Fetal distress 30%c. IUGR 10%d. APH ,, Abruption placenta or

placenta previa 10%e. Fetal death 5%

Complications of Premature ,IUGR or SGA Infants

RDSIVHNECInfectionAnemiaPDA Apnea

Complications of Premature ,IUGR or SGA Infants

Metabolic disorders: Hypoglycemia, hypocalcemia

HypothermiaHematologic disorders: polycytemiaHypoxia: birth asphyxia, meconium

aspiration, Associated withCongenital

malformation

Ref: Utpala G et al: Pediatr Clin N Am 2004;51: 639-654.

Survival in Premature Infants26 wks – 80%27 wks – 90%28-31 wks – 90 to 95%32-33 wks – 95%34-36 wks – approaches term survival rates

Prevention of PTB

Reduce/eliminate risk factors, if possibleNot proven to be effective: bedrest, home

uterine monitoring, prophylactic tocolytics, prophylactic antibiotics, abstinence

Supplemental progesteroneWomen with previous spontaneous preterm

delivery at less than 34 weeks gestation

Prevention of PTBCervical cerclage Shirodkar / Mc Donald

Amnio-reduction in Polyhydramnios

Early treatment of UTI or Bacteriuria

Embryo reductions in IVF

Prediction / Detection1. Assessment of risk factors 2. Vaginal examination to assess the cervical

status 3. Ultrasound visualization of cervical length

and dilatation 4. Detection of foetal fibronectin in

cervicovaginal secretions

Sonographic Cervical Length

•More than3.5 •No funneling

Management :Antenatal Steroids

Indicated in the delivery of a fetus at 24-34 weeks’ gestation in the absence of clinical infection.

Why?Reduces the incidence of RDS, IVH and

NEC. Delay of delivery- A minimum of 24

hours.Betamethasone or Dexamethasone &

HowSingle /multiple courses

Tocolysis:Beta agonists (ritodrine, terbutaline)

Were 1st drugs of choiceS/E Tachycardia, hypotension, tremor, palpitations,

chest discomfort, hypokalemia, hyperglycemia

Magnesium sulfate esp. with severe PET

Nausea, flushing, fatigue, respiratory depression, cardiac arrest

Indomethacin Esp. with Polyhydramnois Maternal GI /se ,premature closure of ductus &

oligohydramnios

Tocolysis:Nifidipine Cheap, with high BP / PET (calcium channel

blocker)

AtosibanThe most used one now . Oxytocin receptor antagonistTractocile

PROM/PPROMRisks:Cord prolapsePTLInfectionPulmonary hypoplasia, Skeletal

deformities.

management of P/PROM

DiagnosisExpectant management versus intervention Maternal / Foetal surveillanceHospital/ HomeSteroids.AntibioticsTiming of delivery.

Management of Premature InfantsDelivery room

managementTemperature and

humidity controlFluids and

electrolytesBlood glucoseCalciumNutrition

Respiratory supportSurfactantPDATransfusionSkin careOther special

considerations

THANK YOUAny Question